SHM Converge Scientific Abstract ePoster Gallery-Implementing a Penicillin Allergy De-Labeling Project in Hospitalized Adults

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This project addressed the problem of unverified penicillin allergy labels, which can lead to avoidable use of broader-spectrum antibiotics and missed opportunities for better care. The team showed that some low-risk penicillin allergies do not require traditional skin testing and can be safely evaluated using an algorithmic approach.<br /><br />The aim was to de-label 25 hospitalized internal medicine patients with reported penicillin allergy who needed one dose of antibiotics during admission. A multidisciplinary team of an internal medicine resident, infectious diseases physician, and pharmacist supported the primary teams but did not directly interact with patients. The project used a one-page allergy questionnaire based on the validated PEN-FAST tool and a one-page algorithm to guide patient selection and oral amoxicillin challenge administration. Educational sessions were also held for residents, attendings, pharmacists, and nursing leadership to promote confidence in direct de-labeling and oral challenge methods and support sustainability.<br /><br />During the study period, 27 de-labeling events occurred. Of eligible patients, 59% were successfully de-labeled. This included 16 oral amoxicillin challenges and 11 direct de-labeling events based on allergy assessment alone. In 25 of the 27 cases, antibiotic therapy was narrowed to penicillin or another beta-lactam, supporting antibiotic stewardship. There were two delayed rash reactions, both resolved with oral antihistamines and did not require further escalation of care, though they did require use of a non-penicillin alternative.<br /><br />Overall, the project demonstrated that structured assessment and oral challenge can safely and effectively de-label selected patients with low-risk penicillin allergies, reducing unnecessary restrictions on antibiotic choice and improving high-value care.

Asset Subtitle

Kelli A. Bagwell

Meta Tag

Author List Dusten Rose, Kelli A. Bagwell, Parker Hudson

Category Innovations

Concept Penicillin Allergy

Concept Delabeling

Concept Allergy Evaluation

Concept PEN-FAST Score

Concept Oral Amoxicillin Challenge

Distinguished Non-Finalist

Presenter Organization University of Texas at Austin Dell Medical School

Presenting Author Kelli A. Bagwell

Track Quality Improvement

Keywords

penicillin allergy

de-labeling

oral amoxicillin challenge

PEN-FAST

antibiotic stewardship

beta-lactam antibiotics

low-risk allergy

hospitalized patients

internal medicine

allergy assessment

Penicillin Allergy

Delabeling

Allergy Evaluation

PEN-FAST Score

Oral Amoxicillin Challenge